Expandable, adjustable inter-body fusion devices and methods

ABSTRACT

An expandable, adjustable inter-body fusion device is presented. The inter-body fusion device can have a first plate, a second plate, and an insert positioned substantially therebetween the first plate and the second plate. The first plate, the second plate, and the insert define an interior cavity. Moving the insert longitudinally with respect to the first and second plates increases or decreases the distance of the first plate with respect to the second plate, effectively expanding the inter-body fusion device and increasing the volume of the interior cavity. The angle between the first plate and the second plate is selectively adjustable.

RELATED APPLICATIONS

This application is a continuation of co-pending U.S. Ser. No. 15/549,169 entitled “Expandable, Adjustable Inter-Body Fusion Devices And Methods”, which is a national stage entry of PCT/US16/16899 filed on Feb. 5, 2016 claiming priority to U.S. provisional application 62/112,332 filed on Feb. 5, 2015; and this application is a continuation of co-pending U.S. Ser. No. 16/708,209 filed on Dec. 9, 2019 entitled “Expandable, Adjustable Inter-Body Fusion Devices And Methods”, which is a continuation of U.S. Ser. No. 16/210,240 filed on Dec. 5, 2018 now U.S. Pat. No. 10,500,064 issued on Dec. 10, 2019 which is a continuation of U.S. Ser. No. 15/521,995 filed on Apr. 26, 2017 now U.S. Pat. No. 10,285,824 issued on May 15, 2019 which is a national stage entry of PCT/US2015/057892 filed on Oct. 28, 2015 claiming priority to U.S. provisional application 62/069,362 filed on Oct. 28, 2014.

FIELD OF THE INVENTION

This invention relates generally to spinal surgery, and more particularly to devices and methods for stabilization of the spine in association with placement of an expandable inter-body construct with an adjustable construct angle for inter-body fusion or the like.

BACKGROUND OF THE INVENTION

Damage or disease that affects the spinal disc within an individual's spinal column may lead to neurologic impairment with possible permanent damage to the surrounding tissue. Maintaining proper anatomic spacing and lordosis within the spine is critical to ensuring continued functionality of the surrounding tissue and for the spinal column, the spinal cord and nerve roots and therefore, avoidance of long term serious neurological impairment.

Typically, spinal implants that are used as a spacer type of device have a fixed overall length and are implanted without the ability to adjust the degree of expansion or curvature without using multiple insertion instrumentation. Some of the known procedures for introducing spinal implants comprise Anterior Lumbar Inter-body Fusion (“ALIF”), Lateral Lumbar Inter-body Fusion (“LLIF”), Posterior Lumbar Inter-body Fusion (“PLIF”), Oblique Lumbar Inter-body Fusion (“OLIF”), Direct Lateral Fusion (“DLIF”), Transforaminal Lumbar Inter-body Fusion (“TLIF”), and the like. A need remains for an expandable, adjustable spacer type of implant that allows the surgeon to insert the implant in an unexpanded position to minimize the size of the surgical incision, facilitate the operative technique and decrease patient morbidity.

SUMMARY OF THE INVENTION

Presented herein is an inter-body fusion device, or implant, for use in spinal surgery. In one aspect, the inter-body fusion device can be an expandable fusion device having an expandable height and volume. In another aspect, the inter-body fusion device can be an adjustable fusion device such that an angle formed between an upper bone contact surface and a lower bone contact surface is selectively adjustable by the surgeon.

In one aspect, the inter-body fusion device comprises a first plate, a second plate, and an insert positioned substantially therebetween the first plate and the second plate. The first plate, the second plate, and the insert define an interior cavity. In one aspect, moving at least a portion of the insert longitudinally with respect to the first and second plates in a first direction increases the distance between the first plate relative to the second plate, effectively expanding the inter-body fusion device and increasing the volume of the interior cavity. In another aspect, moving at least a portion of the insert longitudinally with respect to the first and second plates in the first direction increases the angle formed between the first plate relative to the second plate.

It is contemplated that this technology can be used for a variety of implants used for a variety of spinal procedures. These procedures include, but are not limited to OLIF (anterior or posterior), DLIF, PLIF, TLIF, ALIF, and LLIF. So, depending upon the procedure and point of insertion for the implant, the geometry of the implant can differ.

In an exemplified aspect, at least one of the first plate and the second plate define at least one graft window that is in communication with the interior cavity.

Also presented herein is a method of using an inter-body fusion device during an inter-body fusion procedure. In one aspect, the method comprises accessing the desired disc space, choosing the correct insert size with the appropriate height range, inserting the inter-body fusion device into the desired area in the disc space, expanding the inter-body fusion device from a first unexpanded position to a second expanded position and adjusting the angle formed between the first plate relative to the second plate to a desired angle. An additional step of packing the interior cavity via with bone fusion material either prior to or after expansion is also contemplated.

Related methods of operation are also provided. Other apparatuses, methods, systems, features, and advantages of the inter-body fusion device and the method of its use will be or become apparent to one with skill in the art upon examination of the following figures and detailed description. It is intended that all such additional apparatuses, methods, systems, features, and advantages be included within this description, be within the scope of the inter-body fusion device and the method of its use, and be protected by the accompanying claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate certain aspects of the instant invention and together with the description, serve to explain, without limitation, the principles of the invention. Like reference characters used therein indicate like parts throughout the several drawings.

FIG. 1 is a front perspective view of one embodiment of an expandable, adjustable inter-body fusion device in a second expanded position, the device comprising a first plate, a second plate and an insert, according to one aspect;

FIG. 2 is a front perspective of the inter-body fusion device of FIG. 1 in the second expanded position, in which a device angle between the first plate and the second plate is substantially 0 degrees (the first plate and the second plate are substantially parallel), and in which the first plate is illustrated transparently for clarity;

FIG. 3 is a front perspective of the inter-body fusion device of FIG. 1 in a first unexpanded position;

FIG. 4 is a front perspective of the inter-body fusion device of FIG. 1 in the second expanded position, and in which the device angle between the first plate and the second plate is greater than 0 degrees;

FIG. 5 is front perspective view of the insert of FIG. 1 , according to one aspect;

FIG. 6 is a side elevational view of the insert of FIG. 5 ;

FIG. 7 is a rear perspective view of the insert of FIG. 5 ;

FIG. 7A is a rear perspective view of a first member of the insert of FIG. 5 .

FIG. 7B is a rear perspective view of a second member of the insert of FIG. 5 .

FIG. 8 is a front perspective of the inter-body fusion device of FIG. 1 in the second expanded position, in which the device angle between the first plate and the second plate is substantially 0 degrees, and in which the first plate is illustrated transparently for clarity, showing the inter-body fusion device coupled to a device driver, according to one aspect;

FIG. 9 is a front perspective of the inter-body fusion device of FIG. 1 in the second expanded position, in which the device angle between the first plate and the second plate is greater than 0 degrees, and in which the first plate is illustrated transparently for clarity, showing the inter-body fusion device coupled to a device driver, according to one aspect;

FIG. 10 is a front perspective of the inter-body fusion device of FIG. 1 in the first unexpanded position, in which the first plate is illustrated transparently for clarity, showing the inter-body fusion device coupled to a device driver, according to one aspect;

FIG. 11 is a rear perspective of the inter-body fusion device of FIG. 1 in the second expanded position, in which the first plate is illustrated transparently for clarity, showing the inter-body fusion device coupled to a device driver, according to one aspect;

FIG. 12 is side elevational of the device driver of FIG. 9 , showing the device driver coupled to the inter-body fusion device of FIG. 1 , according to one aspect;

FIG. 13 is a front perspective view of a second embodiment of an expandable, adjustable inter-body fusion device in a first unexpanded position, the device comprising a first plate, a second plate and an insert, according to one aspect;

FIG. 14 is a perspective view of the inter-body fusion device of FIG. 13 in the first unexpanded position, in which the first plate is illustrated transparently for clarity;

FIG. 15 is a perspective view of the inter-body fusion device of FIG. 13 in a second expanded position in which the device angle between the first plate and the second plate is substantially 0 degrees.

FIG. 16 is a perspective view of the inter-body fusion device of FIG. 13 in the second expanded position in which the device angle between the first plate and the second plate is substantially 0 degrees and in which the first plate is illustrated transparently for clarity;

FIG. 17 is a perspective view of the inter-body fusion device of FIG. 13 in the second expanded position and in which the device angle between the first plate and the second plate is greater than 0 degrees;

FIG. 18 is a perspective view of the inter-body fusion device of FIG. 13 in the second expanded position, in which the device angle between the first plate and the second plate is greater than 0 degrees and in which the first plate is illustrated transparently for clarity;

FIG. 19 is a perspective view of the insert of the inter-body fusion device of FIG. 13 , according to one aspect;

FIG. 20 is a side elevational view of the insert of FIG. 19 ;

FIG. 21 is a front perspective view of a third embodiment of an expandable, adjustable inter-body fusion device in a second expanded position, the device comprising a first plate, a second plate and an insert, and in which a device angle between the first plate and the second plate is substantially 0 degrees, according to one aspect;

FIG. 22 is a perspective view of the inter-body fusion device of FIG. 21 in a first unexpanded position, in which the first plate is illustrated transparently for clarity;

FIG. 23 is a perspective view of the inter-body fusion device of FIG. 21 in the second expanded position, in which the device angle between the first plate and the second plate is greater than 0 degrees and in which the first plate is illustrated transparently for clarity;

FIG. 24 is a front perspective view of a fourth embodiment of an expandable, adjustable inter-body fusion device in a second expanded position, the device comprising a first plate, a second plate and an insert, and in which a device angle between the first plate and the second plate is substantially 0 degrees, according to one aspect;

FIG. 25 is a perspective view of the inter-body fusion device of FIG. 24 in a first unexpanded position, in which the first plate is illustrated transparently for clarity;

FIG. 26 is a perspective view of the inter-body fusion device of FIG. 24 in the second expanded position, in which the device angle between the first plate and the second plate is greater than 0 degrees and in which the first plate is illustrated transparently for clarity;

FIG. 27 is a front perspective view of the inter-body fusion device of FIG. 24 in the second expanded position, in which a device angle between the first plate and the second plate is substantially 0 degrees, and in which a first member of the insert is separate from the second member of the insert, according to one aspect;

FIG. 28 is a perspective view of the inter-body fusion device of FIG. 27 in the second expanded position, in which the first plate is illustrated transparently for clarity; and

FIG. 29 is a perspective view of the inter-body fusion device of FIG. 27 in the second expanded position, in which the device angle between the first plate and the second plate is greater than 0 degrees and in which the first plate is illustrated transparently for clarity.

DETAILED DESCRIPTION OF THE INVENTION

The present invention can be understood more readily by reference to the following detailed description, examples, and claims, and their previous and following description. Before the present system, devices, and/or methods are disclosed and described, it is to be understood that this invention is not limited to the specific systems, devices, and/or methods disclosed unless otherwise specified, as such can, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting.

The following description of the invention is provided as an enabling teaching of the invention in its best, currently known aspect. Those skilled in the relevant art will recognize that many changes can be made to the aspects described, while still obtaining the beneficial results of the present invention. It will also be apparent that some of the desired benefits of the present invention can be obtained by selecting some of the features of the present invention without utilizing other features. Accordingly, those who work in the art will recognize that many modifications and adaptations to the present invention are possible and can even be desirable in certain circumstances and are a part of the present invention. Thus, the following description is provided as illustrative of the principles of the present invention and not in limitation thereof.

As used herein, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to a “plate” includes aspects having two or more plates unless the context clearly indicates otherwise.

Ranges can be expressed herein as from “about” one particular value, and/or to “about” another particular value. When such a range is expressed, another aspect includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another aspect. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint.

As used herein, the terms “optional” or “optionally” mean that the subsequently described event or circumstance may or may not occur, and that the description includes instances where said event or circumstance occurs and instances where it does not.

Terms used herein, such as “exemplary” or “exemplified,” are not meant to show preference, but rather to explain that the aspect discussed thereafter is merely one example of the aspect presented.

Additionally, as used herein, relative terms, such as “substantially”, “generally”, “approximately”, and the like, are utilized herein to represent an inherent degree of uncertainty that may be attributed to any quantitative comparison, value, measurement, or other representation. These terms are also utilized herein to represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue.

In one aspect, presented herein is an inter-body fusion device for use in spinal surgery, such as, but not limited to, ALIF, OLIF, TLIF, LLIF, PLIF, and DLIF procedures. In another aspect, the inter-body fusion device can be an expandable inter-body fusion device such that a height of the device can be selectively adjusted by a user, such as a surgeon. In a further aspect, the inter-body fusion device can be an adjustable fusion device such that a device angle formed between an upper bone contact surface and a lower bone contact surface is selectively adjustable by the user. In another aspect, the inter-body fusion device can be an expandable, adjustable inter-body fusion device having a selectively expandable height and a selectively adjustable device angle.

In one aspect and as illustrated in FIGS. 1-4 , the inter-body fusion device 10 comprises a first plate 100, a second plate 200, and an insert 300 positioned substantially therebetween the first plate 100 and the second plate 200. The first plate has a leading edge or end 102, a trailing edge or end 104, an upper bone contact surface 110 and an opposed first plate inner surface 120. The second plate 200 has a leading edge or end 202, a trailing edge or end 204, a lower bone contact surface 210 and an opposed second plate inner surface 220. In one aspect, the first plate 100, the second plate 200, and the insert 300 define an interior cavity 15.

In one aspect, moving at least a portion of the insert 300 longitudinally with respect to the first plate 100 and the second plate 200 (that is, either toward the leading end 20 or toward the trailing end 30 of the device) can increase the distance between the first plate relative to the second plate, effectively expanding the inter-body fusion device and increasing the volume of the interior cavity 15. In another aspect, a device angle α1 formed between a longitudinal axis L1 of the first plate 100 and a longitudinal axis L2 of the second plate 200 can be selectively adjusted by a user to vary the volume of the interior cavity and/or better position the device 10 in the disc space. For example, the device angle α1 can be substantially 0 degrees such that the first plate and the second plate are substantially parallel to each other. In other examples, the device angle α1 can be an acute angle of about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees or greater than about 45 degrees.

At least one of the first plate 100 and the second plate 200 has at least one longitudinal sidewall 130, 230 extending substantially between the respective inner surface 120, 220 and bone contact surface 110, 210. In one aspect, the at least one longitudinal sidewall 130, 230 comprises a plurality of longitudinal sidewalls. For example, the longitudinal sidewall can comprise two longitudinal sidewalls. In another aspect, the longitudinal sidewall(s) can be positioned substantially near a peripheral edge 139, 239 of the first and/or second plate.

In one aspect, the longitudinal sidewall 130 of the first plate 100 can define at least one slot 132 having a slot axis L4. In another aspect, the at least one slot of the first plate can comprise a plurality of slots, such as, for example and without limitation, a first inclined slot 140 and a second inclined slot 144. Each slot can have a leading end 133 and a trailing end 135, the leading end being positioned closer to the leading edge or end 102 of the first plate 100. In another aspect, the first slot and/or the second slot can be positioned along the slot axis L4 that is substantially transverse to the longitudinal axis L1 of the first plate 100. Optionally, however, the slot axis L4 of the first slot 140 and/or the second slot 144 can be at an acute slot angle relative to the longitudinal axis L1 of the first plate. That is, the slot axis of the first slot 140 and/or the second slot 144 can be at an acute surface angle α2 relative to the longitudinal axis L1 of the first plate. For example, the surface angle α2 can be about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees or greater than about 45 degrees. In another aspect, the slot axis L4 of the first slot 140 and the slot axis of the second slot 144 can be substantially parallel to each other. Alternatively, the slot axis of the first slot can be at an angle relative to the slot axis of the second slot. For example, the slot axis L4 of the first slot 140 can be at an acute angle relative to the slot axis of the second slot 144, or the slot axis of the first slot can be substantially transverse to the slot axis of the second slot. The first slot 140 can be sized, shaped and positioned to engage a portion of a first member 302 of the insert 300, and the second slot can be sized, shaped and positioned to engage a portion of a second member 304 of the insert. In a further aspect, the at least one slot 132 can have an inclined slot wall 134.

In another aspect, the longitudinal sidewall of the first plate 100 can have a wall width of a predetermined thickness. The longitudinal sidewall 130 of the first plate can further comprise at least one substantially flat surface 136 that is substantially parallel to the longitudinal axis L1 of the first plate, according to another aspect. Optionally, the longitudinal sidewall 130 of the first plate 100 can comprise an upper flat surface 138, a first inclined surface 141, a lower flat surface 142 and a second inclined surface 143. In this aspect, the upper flat surface and the lower flat surface can be spaced from each other a predetermined distance that is less than the height of the insert 300. Alternatively, the upper flat surface 138 and the lower flat surface 142 can be spaced from each other a predetermined distance that is greater than or equal to the height of the insert. In one aspect, the first inclined surface and the second inclined surface can be substantially parallel to each other. Optionally, the first inclined surface 141 can be at an angle relative to the second inclined surface 143. At least one pin bore 146 can be defined in a portion of the longitudinal sidewall 130.

In one aspect, the longitudinal sidewall 230 of the second plate 200 can define at least one slot 232 having a slot axis L5. In another aspect, the at least one slot of the second plate can comprise a plurality of slots, such as, for example and without limitation, a first inclined slot 240 and a second inclined slot 244. Each slot can have a leading end 233 and a trailing end 235, the leading end being positioned closer to the leading edge or end 202 of the second plate 200. In another aspect, the first slot and/or the second slot can be positioned along the slot axis L5 that is substantially transverse to the longitudinal axis L2 of the second plate 200. Optionally, the slot axis L5 of the first slot 240 and/or the second slot 244 can be at an acute slot angle relative to the longitudinal axis L2 of the second plate. That is, at the slot axis of the first slot and/or the second slot can be at an acute surface angle α3 relative to the longitudinal axis L2 of the second plate. For example, the surface angle α3 can be about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees or greater than about 45 degrees. In another aspect, the slot axis L5 of the first slot 240 and the slot axis of the second slot 244 can be substantially parallel to each other. Alternatively, the slot axis of the first slot can be at an angle relative to the slot axis of the second slot. For example, the slot axis L5 of the first slot 240 can be at an acute angle relative to the slot axis of the second slot 244, or the slot axis of the first slot can be substantially transverse to the slot axis of the second slot. The first slot 240 can be sized, shaped and positioned to engage a portion of a pin 400 coupled to the first member 302, and the second slot 244 can be sized, shaped and positioned to engage a pin coupled to the second member 304. In a further aspect, the at least one slot 232 can have an inclined slot wall 234.

In one aspect, the longitudinal sidewall of the second plate 200 can have a slot wall width of a predetermined thickness. The longitudinal sidewall 230 of the second plate can further comprise at least one substantially flat surface 236 that is substantially parallel to the longitudinal axis L2 of the second plate, according to another aspect. Optionally, the longitudinal sidewall 230 of the second plate 200 can comprise a lower flat surface 238, a first inclined surface 241, an upper flat surface 242 and a second inclined surface 243. In this aspect, the upper flat surface and the lower flat surface can be spaced from each other a predetermined distance that is less than the height of the insert 300. Alternatively, the upper flat surface 242 and the lower flat surface 238 can be spaced from each other a predetermined distance that is greater than or equal to the height of the insert. In one aspect, the first inclined surface and the second inclined surface can be substantially parallel to each other. Optionally, the first inclined surface 241 can be at an angle relative to the second inclined surface 243. At least one pin bore 246 can be defined in a portion of the longitudinal sidewall 230.

Referring now to FIGS. 5-7 , in one exemplified aspect, the insert 300 comprises a first member 302 and a second member 304. In one aspect, the first member can be spaced from the second member a predetermined distance. In another aspect, the first member 302 can be physically separate from the second member 304, as in FIG. 5 . Optionally, a portion of the first member can be coupled to the second member (as illustrated in FIG. 19 ). In one aspect, the first and second members operate independently, enabling a user to selectively alter both the distance between the first plate and the second plate and the device angle.

In one aspect, the first member 302 has a leading edge or end 306, a trailing edge or end 308, an upper plate contact surface 310 extending between the leading edge or end and the trailing edge or end, and an opposed lower plate contact surface 312 extending between the leading edge or end 306 and the trailing edge or end 308. At least one longitudinal sidewall 314 can extend substantially between the upper plate contact surface and the opposed lower plate contact surface. A first bore 316 can be defined in a portion of the trailing edge or end of the first member. In another aspect, at least a portion of the first bore can be threaded.

The first member 302 can comprise a first threaded shaft 318 and an optional first retainer 320, according to one aspect. The first retainer can be configured to couple a portion of the first member 302 to at least one of the first plate 100 and the second plate 200. In another aspect, the first threaded shaft can be coupled to a portion of the first retainer 320 and can be configured to complementarily engage a portion of the first bore 316. Thus, rotation of the first threaded shaft 318 can cause the distance between the trailing edge or end 308 of the first member 302 and the first retainer to change. For example, rotation of the first threaded shaft in a first direction can make the distance between the trailing edge or end of the first member and the first retainer 320 smaller. In another example, rotation of the first threaded shaft 318 in a second direction that is opposed to the first direction can make the distance between the trailing edge or end 308 of the first member 302 and the first retainer 320 larger. A distal end 319 of the first threaded shaft can be configured to engage an actuation device, such as a screwdriver and the like so that rotation of the actuation device can rotate the first threaded shaft 318. For example, the distal end of the first threaded shaft 318 can be slotted to engage a regular screwdriver. In another example, the distal end 319 of the first threaded shaft can be shaped to engage a hexagonal driver and the like. A shoulder 321 and/or a locking washer 323 of the second threaded shaft can engage a portion of the second retainer 338 to restrict longitudinal movement of the second threaded shaft 336.

As illustrated in FIGS. 7 and 7A, the first member 302 can define at least one insert slot 350 in a portion of the trailing edge or end 308 and/or the lower plate contact surface 312. In one aspect, the at least one insert slot can have a slot axis L6 that is in a slot plane that is substantially parallel to a longitudinal axis L3 of the insert 300. Optionally, the at least one insert slot can comprise a plurality of insert slots such that an insert slot can be defined in the first member on each side of the first bore 316. In another aspect, each insert slot 350 can have an inclined insert slot wall 352. That is, at least a portion of the at least one insert slot of the first member 302 can be an inclined surface that is at an acute surface angle α4 relative to the longitudinal axis L3 of the insert. For example, the surface angle α4 can be about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees or greater than about 65 degrees. In another aspect, the insert slot 350 of the first member can have a slot width of a predetermined thickness that is greater than at least a portion of the wall thickness of the longitudinal sidewall 130, 230 of the first plate 100 and/or the second plate 200. At least one pin bore 315 can be defined in a portion of the longitudinal sidewall 314. In one aspect, the pin bore can extend through the insert slot as can be seen in FIG. 7A.

In one aspect, a first portion 354 of the longitudinal sidewall 314 of the first member 302 can be recessed relative to a second portion 356. For example, the first portion of the longitudinal sidewall can be spaced from the second portion a predetermined sidewall distance. This predetermined sidewall distance can be the width of a sidewall shoulder 358 formed between the first portion 354 and the second portion 356 of the sidewall. In another aspect, at least a portion of the sidewall shoulder of the first member 302 can be an inclined surface that is at an acute surface angle αs relative to the longitudinal axis L3 of the insert. For example, the surface angle αs can be about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees or greater than about 65 degrees. In another aspect, the sidewall shoulder 358 of the first member can have a shoulder width of a predetermined thickness that is greater than, equal to, or less than at least a portion of the wall thickness of the longitudinal sidewall 130, 230 of the first plate 100 and/or the second plate 200. As can be appreciated, the sidewall shoulder can be formed on any or all longitudinal sidewalls 314 of the first member 302.

At least one tab 360 can extend from the first portion 354 of each longitudinal sidewall 314 of the first member 302, according to one aspect. In another aspect, the at least one tab can be substantially circular, substantially oval and the like. An outer wall 362 of the at least one tab can substantially align with a portion of the trailing edge or end 308 and/or the upper plate contact surface 310 of the first member. In a further aspect, the at least one tab 360 can have a tab length substantially equal to the width of the sidewall shoulder 358 of the first member. Optionally, the tab length can be greater than or less than the width of the sidewall shoulder of the first member 302. In still another aspect, at least a portion of the tab 360 can be spaced from and overlie the sidewall shoulder 358.

With reference again to FIGS. 5-7 , the second member 304 has a leading edge or end 322, a trailing edge or end 324, an upper plate contact surface 326 extending between the leading edge or end and the trailing edge or end and an opposed lower plate contact surface 328 extending between the leading edge or end 322 and the trailing edge or end 324. At least one longitudinal sidewall 330 can extend substantially between the upper plate contact surface and the opposed lower plate contact surface. A second bore 332 can extend through the second member from the leading edge or end to the trailing edge or end of the second member. In another aspect, the second bore can define a longitudinal pathway 334, and at least a portion of the second bore can be threaded. For example, the second bore 332 can extend longitudinally through the second member 304, and a portion or all of the second bore can be threaded.

The second member 304 can comprise a second threaded shaft 336 and an optional second retainer 338, according to one aspect. The second retainer can be configured to couple a portion of the second member 304 to at least one of the first plate 100 and the second plate 200. In another aspect, the second threaded shaft can be coupled to a portion of the second retainer and configured to complementarily engage a portion of the second bore 332. Thus, rotation of the second threaded shaft 336 can cause the distance between the trailing edge or end 324 of the second member 304 and the second retainer to change. For example, rotation of the second threaded shaft in a first direction can make the distance between the trailing edge or end of the second member and the second retainer 338 smaller. In another example, rotation of the second threaded shaft 336 in a second direction that is opposed to the first direction can make the distance between the trailing edge or end 324 of the second member 304 and the second retainer 338 larger. A distal end 337 of the second threaded shaft can be configured to engage an actuation device, such as a screwdriver and the like so that rotation of the actuation device can rotate the second threaded shaft 336. For example, the distal end of the second threaded shaft can be slotted to engage a regular screwdriver. In another example, the distal end 337 can be shaped to engage a hexagonal driver and the like. In one aspect, a longitudinal duct 339 can be defined therethrough the second threaded shaft. In use, the longitudinal duct of the second threaded shaft can be substantially coaxially aligned with the longitudinal pathway 334 of the second member so that at least a portion of the actuation device can be inserted through both the longitudinal duct 339 of the second threaded shaft 336 and the longitudinal pathway 334 of the second member 304. A shoulder 346 and/or a locking washer 347 of the second threaded shaft can engage a portion of the second retainer 338 to restrict longitudinal movement of the second threaded shaft 336.

As illustrated in FIGS. 7 and 7B, the second member 304 can define at least one insert slot 364 in a portion of the leading edge or end 322 and/or the lower plate contact surface 328. In one aspect, the at least one insert slot can have a slot axis L5 that is in a slot plane that is substantially parallel to a longitudinal axis L3 of the insert 300. Optionally, the at least one insert slot can comprise a plurality of insert slots such that an insert slot can be defined in the second member on each side of the second bore 332. In another aspect, each insert slot 364 can have an inclined insert slot wall 366. That is, at least a portion of the at least one insert slot of the second member 304 can be an inclined surface that is at an acute surface angle α6 relative to the longitudinal axis L3 of the insert. For example, the surface angle α6 can be about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees or greater than about 65 degrees. In another aspect, the insert slot 364 of the second member 304 can have a slot width of a predetermined thickness that is greater than at least a portion of the wall thickness of the longitudinal sidewall 130, 230 of the first plate 100 and/or the second plate 200. At least one pin bore 331 can be defined in a portion of the longitudinal sidewall 330. In one aspect, the pin bore can extend through the insert slot 364 as can be seen in FIG. 7B.

In one aspect, a first portion 368 of the longitudinal sidewall 330 of the second member 304 can be recessed relative to a second portion 370. For example, the first portion of the longitudinal sidewall can be spaced from the second portion a predetermined sidewall distance. This predetermined sidewall distance can be the width of a sidewall shoulder 372 formed between the first portion 368 and the second portion 370 of the sidewall. In another aspect, at least a portion of the sidewall shoulder of the second member 304 can be an inclined surface that is at an acute surface angle α7 relative to the longitudinal axis L3 of the insert 300. For example, the surface angle α7 can be about 1 degree, 2 degrees, 3 degrees, 4 degrees, 5 degrees, 6 degrees, 7 degrees, 8 degrees, 9 degrees, 10 degrees, 11 degrees, 12 degrees, 13 degrees, 14 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees or greater than about 65 degrees. In another aspect, the sidewall shoulder 372 of the second member can have a shoulder width of a predetermined thickness that is greater than, equal to, or less than at least a portion of the wall thickness of the longitudinal sidewall 130, 230 of the first plate 100 and/or the second plate 200. As can be appreciated, the sidewall shoulder can be formed on any or all longitudinal sidewalls 330 of the second member.

At least one tab 374 can extend from the first portion 368 of each longitudinal sidewall 330 of the second member 304, according to one aspect. In another aspect, the at least one tab can be substantially circular, substantially oval and the like. An outer wall 376 of the at least one tab can substantially align with a portion of the leading edge or end 322 and/or the upper plate contact surface 326 of the second member. In a further aspect, the at least one tab 374 can have a tab length substantially equal to the width of the sidewall shoulder 372 of the second member. Optionally, the tab length can be greater than or less than the width of the sidewall shoulder of the second member 304. In still another aspect, at least a portion of the tab 374 can be spaced from and overlie the sidewall shoulder 372.

Referring again to FIGS. 1-4 , the inter-body fusion device 10 can further comprise at least one pin 400 configured to couple a portion of the insert 300 to at least one of the first plate 100 and the second plate 200. For example, a proximal end 402 of a pin can be formed with or securely attached to the pin bore 146 of the longitudinal sidewall 130 of the first plate and/or the pin bore 246 of the longitudinal sidewall 230 of the second plate such that a distal end 404 of the pin 400 extends from the sidewall into the interior cavity 15 of the device 10. In another example, the proximal end 402 and the distal end 404 of a pin can be formed with or securely attached to the pin bore 315, 331 of the longitudinal sidewall 314, 330 of the first member 302 and/or the second member 304 such that a central portion 406 of the pin is positioned in the insert slot 350, 364. In one aspect, at least one pin can be positioned such that a longitudinal axis of the pin is substantially transverse to the longitudinal axis L1 of the first plate 100. In another aspect, a portion of at least one pin 400 can be configured to slidingly engage a first slot 340 defined in the first retainer 320 and/or a second slot 342 defined in the second retainer 338 of the insert 300. In another aspect, the first slot and/or the second slot can be substantially transverse to a longitudinal axis L3 of the insert. Optionally, however, the first slot 340 and/or the second slot 342 can be at an acute angle relative to the longitudinal axis L3 of the insert. In still another aspect, a portion of at least one pin 400 can be configured to slidingly engage the slot wall 234 of the at least one slot 232 defined in the second plate 200.

As can be appreciated, the at least one pin 400 can comprise a plurality of pins. In one non-limiting example, the device 10 of FIGS. 1-4 comprises 12 pins, though it is of course contemplated that more or less pins can be used. Further, the pins can be placed in other arrangements than those shown.

In use, described more fully below, portions of the at least one tab 360, 374 of the first member 302 and/or the second member 304 can be configured to slidingly engage the inclined slot wall 134 of the slot 132 of the first plate 100 of the device 10. For example, portions of the tab 360 of the first member can be configured to be inserted into and engage a portion of the slot wall of the first slot 140 of the first plate, and portions of the tab 374 of the second member 304 can be configured to be inserted into and engage a portion of the slot wall of the second slot 144 of the first plate 100.

In another aspect, portions of the inclined insert slot wall 352, 366 of the first member 302 and/or the second member 304 can be configured to engage the first inclined surface 241 and/or the second inclined surface 243 of the second plate 200. Optionally, a pin 400 inserted through the pin bore 315, 331 of the first member and/or the second member can be configured to engage the slot wall 234 of the second plate 200. For example, a first pin 400 can be inserted through the pin bore 315 of the first member 302 and the first inclined slot 240 of the second plate so that the central portion 406 of the pin slidingly engages the inclined slot wall 234, and a second pin can be inserted through the pin bore 331 of the second member 304 and the second inclined slot 244 of the second plate 200 so that the central portion 406 of the pin slidingly engages the inclined slot wall. As seen in the FIGS. 1-4 , the inclined slot walls of the upper and lower plates can cooperate with the pins 400 or tabs of the insert to cam or wedge the first plate 100 and/or the second plate 200 to a desired position and orientation relative to each other based on the position of the first member 302 and the second member 304 relative to the plates.

To assemble the inter-body fusion device 10, the insert 300 can be positioned between the first plate 100 and the second plate 200 such that the leading edge or end 306 of the insert, the leading edge or end 102 of the first plate, and the leading edge or end 202 of the second plate are facing the same direction. In one aspect, portions of the first plate 100 can overlie the second plate 200. Correspondingly, in one aspect, each longitudinal sidewall 130 of the first plate 100 can substantially align with a longitudinal sidewall 230 of the second plate 200. For example, each longitudinal sidewall of the first plate can substantially overlie at least a portion of a longitudinal sidewall of the second plate. Optionally, each longitudinal sidewall 130 of the first plate 100 can be positioned adjacent to at least a portion of a longitudinal sidewall 230 of the second plate 200 so that the inner surface 120 of the first plate and the inner surface 220 of the second plate do not contact each other. Portions of the at least one tab 360, 374 of the first member 302 and/or the second member 304 can be positioned in the inclined slot wall 134 of the slot 132 of the first plate 100 of the device 10.

A pin 400 can be inserted through at least one pin bore 315, 331 of the first member 302 and the first inclined slot 240 of the second plate so that the central portion 406 of the pin slidingly engages the inclined slot wall 234. The proximal end 402 of at least one pin 400 can be coupled to the longitudinal sidewall 130, 230 of at least one of the first and second plate 100, 200 and the distal end 404 of the pin can extend into the first slot 340 or the second slot 342 of the insert 300. Thus, when assembled, a portion of a pin can slide in the slot and allow the first plate 100, the second plate 200, and/or the insert to move relative to each other in the direction of the slot. A first pin 400 can be inserted through the pin bore 315 of the first member 302 and the first inclined slot 240 of the second plate so that the proximal and distal ends of the pin are positioned in the pin bore 315 and the central portion 406 of the pin slidingly engages the inclined slot wall 234, and a second pin can be inserted through the pin bore 331 of the second member 304 and the second inclined slot 244 of the second plate 200 so that the proximal and distal ends of the pin are positioned in the pin bore 331 and the central portion 406 of the pin is positioned in the slot 232 to slidingly engages the inclined slot wall.

Each set of substantially aligned longitudinal sidewalls (a longitudinal sidewall 130 from the first plate 100 and a longitudinal sidewall 230 from the second plate 200) define at least one void 160, as illustrated in FIGS. 1 and 2 . In another aspect, the at least one void can be sized and shaped to complimentarily accept a portion of the first member 302 or the second member 304 of the insert 300 therein. In this aspect, in a first unexpanded position (as illustrated in FIG. 3 ), each of the first member and the second member of the insert 300 can be positioned substantially within the void 160 formed between the substantially aligned longitudinal sidewalls 130, 230 of the first and second plates 100, 200. In the first unexpanded position, at least one of the first member 302 and the second member 304 can be positioned in the void substantially near or in contact with the upper flat surface 138 and/or the lower flat surface 238 of the respective first and second plates. Note that the first unexpanded position is the position in which the inter-body fusion device 10 can be inserted between the adjacent vertebrae of a patient.

In one aspect, in the first unexpanded position, a portion of the longitudinal sidewall 130 of the first plate 100 and the longitudinal sidewall 220 of the second plate 200 can slide by each other until the tab 360 and/or a portion of a pin contacts the leading end 133 of the first slot 140 and/or the trailing end 135 of the second slot 144 and/or, the central portion 406 of a pin positioned in the slot 232 of the second plate contacts the leading end 233 of the first slot 240 and/or the trailing end 235 of the second slot 244. In the second expanded position, a portion of the longitudinal sidewall 130 of the first plate 100 and the longitudinal sidewall 220 of the second plate 200 can slide by each other until the tab 360 and/or a portion of a pin contacts the trailing end 135 of the first slot 140 and/or the leading end 133 of the second slot 144 and/or, the central portion 406 of a pin positioned in the slot 232 of the second plate contacts the trailing end 235 of the first slot 240 and/or the leading end 233 of the second slot 244.

The inter-body fusion device 10 can be selectively expanded about and between the first unexpanded position, in which a portion of at least one of the first member 302 and the second member 304 can be positioned in the void 160 substantially near or in contact with the upper flat surface 138 and/or the lower flat surface 238 of the respective first and second plates 100, 200, and a second expanded position in which a portion of the first member 302 and/or the second member 304 of the insert 300 can be positioned in the void a predetermined distance from the upper flat surface 138 and/or the lower flat surface 238 of the respective first and second plates 100, 200. As can be appreciated, in the second expanded position, the inter-body fusion device 10 can have a height and interior cavity 15 volume that is greater than the height and interior cavity volume of the inter-body fusion device in the first, unexpanded position. Thus, in the first unexpanded position, the interior cavity 15 of the device can have a first cavity size, and in the second expanded position the interior cavity can have a second cavity size that is greater than the first cavity size.

In one aspect, in the first, unexpanded position, the longitudinal axis L1 of the first plate 100 and the longitudinal axis L2 of the second plate 200 can be substantially parallel to each other or, optionally, the longitudinal axis L1 of the first plate and the longitudinal axis L2 of the second plate can be at an acute angle relative to each other. In another aspect, in the second, expanded position, the longitudinal axis L1 of the first plate 100 and the longitudinal axis L2 of the second plate 200 can be substantially parallel to each other or, optionally, the longitudinal axis L1 of the first plate and the longitudinal axis L2 of the second plate can be at an acute angle relative to each other.

In order to selectively expand the inter-body fusion device 10 about and between the first unexpanded position and the second expanded position, at least one of the first member 302 or the second member 304 of the insert 300 can be moved longitudinally about and between a first insert position and a second insert position. In one aspect, in the first insert position, the trailing edge or end 308 of the first member can be spaced from the trailing edge or end 104 of the first plate 100 an unexpanded first distance, and the trailing edge or end 324 of the second member can be spaced from the trailing edge or end 104 of the first plate 100 an unexpanded second distance. In the second insert position, the trailing edge or end 308 of the first member can be spaced from the trailing edge or end 104 of the first plate 100 an expanded first distance that is different than the unexpanded first distance, and the trailing edge or end 324 of the second member can be spaced from the trailing edge or end 104 of the first plate 100 an expanded second distance that is different than the unexpanded second distance. With regards to the device 10 of FIGS. 1-4 , it can be seen that the expanded first distance is less than the unexpanded first distance, and the expanded second distance is greater than the unexpanded second distance.

In moving the inter-body fusion device 10 about and between the first unexpanded position and the second expanded position, the first member 302 and the second member 304 of the insert 300 do not necessarily need be moved simultaneously or to the same insert position. For example, the first member can be in the first insert position while the second member can be in the second insert position. In another example, the first member 302 can be in the second insert position while the second member 304 can be in the first insert position. Thus, the first member and the second member can be in any insert position between the first insert position and the second insert position at any time regardless of the position of the other member.

Upon moving the first member 302 towards the second insert position, at least a portion of the tab 360 of the first member can be moved into contact with the inclined slot wall 134 of the first inclined slot 140 of the longitudinal sidewall 130 of the first plate 100, and at least a portion of the pin 400 extending through pin bore 315 can be moved into contact with the inclined slot wall 234 of the first inclined slot 240 of the longitudinal sidewall 230 of the second plate 200. In this position, the aligned longitudinal sidewalls of the first and second plates 100, 200 can be separated by the first member traveling over the first inclined slots 140, 240 to cam the plates away from each other.

Similarly, upon moving the second member 304 towards the second insert position, at least a portion of the tab 374 of the second member can be moved into contact with the inclined slot wall 134 of the second inclined slot 144 of the longitudinal sidewall 130 of the first plate 100, and at least a portion of the pin 400 extending through the pin bore 331 can be moved into contact with the inclined slot wall 234 of the second inclined slot 244 of the longitudinal sidewall 230 of the second plate 200. In this position, the aligned longitudinal sidewalls of the first and second plates 100, 200 can be separated by the second member traveling over the second inclined slots 144, 244 to cam the plates away from each other.

As one skilled in the art can appreciate, the amount of separation achievable between the first plate 100 and the second plate 200 can be determined by at least the height of the inclined surfaces, the length of the inclined slots and the distance of longitudinal movement of the second member. Further, the angle formed between the first plate and the second plate can be determined by at least the position of the first member 302 of the insert relative to the second member 304.

It is contemplated that this technology can be used for a variety of implants used for a variety of spinal procedures. As mentioned before, these procedures include, but are not limited to OLIF, DLIF, PLIF, ALIF, TLIF, and LLIF. Because of this, depending upon the procedure and point of insertion for the implant, the geometry of the implant can differ. For example, in a DLIF expandable device, the approach is lateral. As such, the upper bone contact surface 110 can be transversely angled with respect to the lower bone contact surface 210 from a first sidewall to a second sidewall to match, increase, or decrease lordosis.

In an OLIF procedure, the inter-body fusion device 10 can be inserted obliquely, either anteriorly or posteriorly. As such, similar to the DLIF implant, the upper bone contact surface 110 can be angled transversely with respect to the lower bone contact surface 210 from the first sidewall to the second sidewall depending on the need to match, increase, or decrease lordosis. In addition, the upper bone contact surface can also be angled longitudinally with respect to the lower bone contact surface from the leading end 20 of the device to the trailing end 30.

In an exemplified aspect, at least one of the first plate 100 and the second plate 200 can define at least one graft window 170, 270 that is in communication with the interior cavity 15. The at least one graft window 170 defined in the first plate can overlie at least a portion of the at least one graft window 270 of the second plate, thereby permitting bone growth therethrough. In another aspect, the upper bone contact surface 110 of the first plate 100 comprises ridges 112 for frictionally engaging a first vertebra of the patient. As can be appreciated, the lower bone contact surface 210 of the second plate can comprise ridges 212 to frictionally engage a second vertebra of the patient.

In one aspect, as shown in FIGS. 8-12 , the inter-body fusion device 10 can be actuated by a device driver 500. The device driver can comprise a first member driver 502 sized and shaped to engage the distal end 319 of the first threaded shaft 318, and a second member driver 504 sized and shaped to engage the distal end 337 of the second threaded shaft 336. In another aspect, the first member driver can be a separate tool than the second member driver. Optionally, however, the first member driver 502 and the second member driver 504 can be integrally formed as illustrated in FIG. 12 . For example, the device driver 500 can further comprise a handle 506 and a clutch collar 508 that allows the device driver to be adjustable between an engaged position and a disengaged position. In the engaged position, the clutch collar can couple the first member driver 502 to the second member driver 504 so that, upon rotation of the handle, both the first member driver and the second member driver rotate at the same speed as the handle. In the disengaged position, the clutch collar 508 can disengage the first member driver 502 from the second member driver 504 so that upon rotation of the handle 506, either the first member driver or the second member driver can rotate at the same speed as the handle while the disengaged driver does not rotate.

In use, the first member driver 502 can be inserted through the longitudinal duct 339 of the second threaded shaft 336 and through the longitudinal pathway 334 of the second member 304 so that the first member driver can be coupled to the distal end 319 of the first threaded shaft 318 of the first member. The second member driver can be coupled to the distal end 337 of the second member. A gripping element 510 of the device driver can grip at least a portion of the inter-body fusion device 10, such as, the first plate 100, the second plate 200, or the insert, such as the second retainer 338 of the insert 300. The clutch collar 508 of the device driver can be placed in the engaged position, and the handle 506 of the device driver can be rotated. For example, if the inter-body fusion device is in the first, unexpanded position, rotation of the handle can cause the first member 302 and the second member 304 of the insert to move from the first insert position towards the second insert position. As the first member and the second member move towards the second insert position, the first plate 100 and the second plate 200 are urged away from each other, and the height of the device increases. In another example, if the inter-body fusion device is in the second expanded position, rotation of the handle can cause the first member 302 and the second member 304 of the insert to move from the second insert position towards the first insert position. As the first member and the second member move towards the first insert position, the first plate 100 and the second plate 200 can move towards each other, and the height of the device decreases.

When the desired device height has been reached, the clutch collar can be moved to the disengaged position. In the disengaged position, rotation of the handle can cause only one of the first member 302 and the second member 304 to move. For example, rotation of the handle in a first direction can cause the first member 302 to move longitudinally towards the trailing edge or end 104 of the first plate, thereby increasing the angle between the longitudinal axis of the first plate and the second plate (the device angle). In another example, rotation of the first member driver 502 in a second direction that is opposed to the first direction can cause the first member 302 to move longitudinally towards the leading edge or end 102 of the first plate 100, thereby decreasing the device angle. When the desired device angle has been reached, the device driver 500 can be removed from the device 10.

A second embodiment of the inter-body fusion device 10 is illustrated in FIGS. 13-20 , according to one aspect. In this embodiment, the inter-body fusion device can be as described above, comprising a first plate 100, a second plate 200, and an insert 300. Optionally, however, in this embodiment, the insert can be a continuous insert. That is, a portion of the first member 302 of the insert 300 can be coupled to a portion of the second member 304 as illustrated in FIG. 19 . In one aspect, the first threaded shaft 318 of the first member can be configured to matingly engage a portion of the second bore 332 of the second member such that rotation of the first threaded shaft can move the first member 302 longitudinally relative to the second member 304. For example, at least a portion of the second bore can be threaded so that rotation of the first threaded shaft 318 can cause the distance between the trailing edge or end 308 of the first member and the leading edge or end 322 of the second member to change. For example, rotation of the first threaded shaft in a first direction can make the distance between the trailing edge or end of the first member 302 and the leading edge or end of the second member 304 smaller. In another example, rotation of the first threaded shaft 318 in a second direction that is opposed to the first direction can make the distance between the trailing edge or end 308 of the first member and the leading edge or end of the second member 304 larger.

Referring still to FIG. 19 , a notch 344 can be defined in a portion of the first member 302, such as, for example, in the upper plate contact surface 310 and/or the lower plate contact surface 312. In one aspect, the notch can be in communication with the first bore 316 so that the first threaded shaft 318 can be inserted through the notch and into the first bore in a direction from the leading edge or end 306 to the trailing edge or end 308 of the first member. In another aspect, the first threaded shaft can be inserted through the notch and through the first bore so that at least a portion of the distal end 319 of the first threaded shaft 318 can engage the threads of the second bore 332 of the second member 304.

Assembly of the inter-body fusion device 10 according to this embodiment can be similar to that described above. In order to selectively expand the inter-body fusion device 10 of FIGS. 13-20 about and between the first unexpanded position and the second expanded position, at least the one of first member 302 or the second member 304 of the insert 300 can be moved longitudinally about and between a first insert position and a second insert position. In one aspect, in the first insert position, the trailing edge or end 308 of the first member can be spaced from the trailing edge or end 104 of the first plate 100 an unexpanded first distance, and the trailing edge or end 324 of the second member can be spaced from the trailing edge or end 104 of the first plate 100 an unexpanded second distance. In the second insert position, the trailing edge or end 308 of the first member can be spaced from the trailing edge or end 104 of the first plate 100 an expanded first distance that is different than the unexpanded first distance, and the trailing edge or end 324 of the second member can be spaced from the trailing edge or end 104 of the first plate 100 an expanded second distance that is different than the unexpanded second distance. With regards to the device 10 of FIGS. 13-20 , it can be seen that the expanded first distance is less than the unexpanded first distance, and the expanded second distance is greater than the unexpanded second distance.

In one aspect, in the first unexpanded position, a portion of the longitudinal sidewall 130 of the first plate 100 and the longitudinal sidewall 220 of the second plate 200 can slide by each other until the tab 360 and/or a portion of a pin contacts the leading end 133 of the first slot 140 and/or the trailing end 135 of the second slot 144 and/or, the central portion 406 of a pin positioned in the slot 232 of the second plate contacts the leading end 233 of the first slot 240 and/or the trailing end 235 of the second slot 244. In the second expanded position, a portion of the longitudinal sidewall 130 of the first plate 100 and the longitudinal sidewall 220 of the second plate 200 can slide by each other until the tab 360 and/or a portion of a pin contacts the trailing end 135 of the first slot 140 and/or the leading end 133 of the second slot 144 and/or, the central portion 406 of a pin positioned in the slot 232 of the second plate contacts the trailing end 235 of the first slot 240 and/or the leading end 233 of the second slot 244.

When adjusting the inter-body fusion device 10 of this embodiment about and between the first unexpanded position and the second expanded position, the first member 302 and the second member 304 of the insert 300 do not necessarily need be moved simultaneously or to the same insert position. For example, the first member can be in the first insert position while the second member can be in the second insert position. In another example, the first member 302 can be in the second insert position while the second member 304 can be in the first insert position. Thus, the first member and the second member can be in any insert position between the first insert position and the second insert position at any time regardless of the position of the other member.

In use, the second member driver 504 can be coupled to the distal end 337 of the second member 304 (as illustrated in FIG. 11 ). If the device is in the first, unexpanded position, rotation of the handle 506 can cause the first member 302 and the second member 304 of the insert to move from the first insert position towards the second insert position, thereby urging the first plate and second plate away from each other. Upon reaching the desired device height, the second member driver can be removed from the second member 304, and the first member driver 502 can be inserted through the longitudinal duct 339 of the second threaded shaft 336 of the second member and through the longitudinal pathway 334 of the second member so that the first member driver can be coupled to the distal end 319 of the first threaded shaft 318 of the first member 302. Rotation of the first member driver can cause the first member to move longitudinally, thereby changing the angle between the first plate and the second plate (the device angle). For example, rotation of the first member driver in a first direction can cause the first member 302 to move longitudinally towards the trailing edge or end 104 of the first plate, thereby increasing the device angle. In another example, rotation of the first member driver 502 in a second direction that is opposed to the first direction can cause the first member 302 to move longitudinally towards the leading edge or end 102 of the first plate 100, thereby decreasing the device angle. When the desired device angle has been reached, the first member driver can be removed from the device 10.

A third embodiment of the inter-body fusion device 10 is illustrated in FIGS. 21-23 . In this embodiment, optionally, the slot axis L4 of the first inclined slot 140 and the slot axis of the second inclined slot 144 of the first plate can be substantially parallel to each other. That is, the surface angle α2 between the slot axis L4 of the first slot and the longitudinal axis L1 of the first plate 100 can be substantially the same as the surface angle α2 between the slot axis L4 of the second slot and the longitudinal axis L1 of the first plate. In another aspect, the slot axis L5 of the first inclined slot 240 and the second inclined slot 244 of the second plate can be substantially parallel to each other. That is, the surface angle α4 between the slot axis L5 of the first slot and the longitudinal axis L2 of the second plate 200 can be substantially the same as the surface angle α4 between the slot axis L5 of the second slot and the longitudinal axis L1 of the second plate.

In order to selectively expand the inter-body fusion device 10 of FIGS. 21-23 about and between the first unexpanded position and the second expanded position, at least one of the first member 302 or the second member 304 of the insert 300 can be moved longitudinally about and between the first insert position and the second insert position. In one aspect, in the first insert position, the trailing edge or end 308 of the first member can be spaced from the trailing edge or end 104 of the first plate 100 an unexpanded first distance, and the trailing edge or end 324 of the second member can be spaced from the trailing edge or end 104 of the first plate 100 an unexpanded second distance. In the second insert position, the trailing edge or end 308 of the first member can be spaced from the trailing edge or end 104 of the first plate 100 an expanded first distance that is different than the unexpanded first distance, and the trailing edge or end 324 of the second member can be spaced from the trailing edge or end 104 of the first plate 100 an expanded second distance that is different than the unexpanded second distance. With regards to the device 10 of FIGS. 21-26 , it can be seen that the expanded first distance is less than the unexpanded first distance, and the expanded second distance is less than the unexpanded second distance.

In one aspect, in the first unexpanded position, a portion of the longitudinal sidewall 130 of the first plate 100 and the longitudinal sidewall 220 of the second plate 200 can slide by each other until the tab 360 and/or a portion of a pin contacts the leading end 133 of the first slot 140 and/or the leading end of the second slot 144 and/or, the central portion 406 of a pin positioned in the slot 232 of the second plate contacts the leading end 233 of the first slot 240 and/or the leading end of the second slot 244. In the second expanded position, a portion of the longitudinal sidewall 130 of the first plate 100 and the longitudinal sidewall 220 of the second plate 200 can slide by each other until the tab 360 and/or a portion of a pin contacts the trailing end 135 of the first slot 140 and/or the trailing end of the second slot 144 and/or, the central portion 406 of a pin positioned in the slot 232 of the second plate contacts the trailing end 235 of the first slot 240 and/or the trailing end of the second slot 244.

A fourth embodiment of the inter-body fusion device 10 is illustrated in FIGS. 24-29 . In this embodiment, the at least one tab 360 of the insert can be replaced with a pin 400 formed integrally with or coupled to the longitudinal sidewall 330 of the insert 300, according to one aspect. In another aspect, the longitudinal axis of the first inclined slot 140 of the first plate 100 can be substantially parallel to the longitudinal axis of the second inclined slot 144 of the first plate. In a further aspect, the longitudinal axis of the first inclined slot 240 of the second plate 200 can be substantially parallel to the longitudinal axis of the second inclined slot 244 of the second plate. In yet another aspect, the slot length of at least one of the first inclined slots 140, 240 and the second inclined slots 144, 244 can be less than the slot length of the embodiments of the device illustrated in FIGS. 1-23 . That is, the length of the at least one slot 132 of the first plate and/or the at least one slot 232 of the second plate can be varied as desired to limit or increase the range of motion of the device 10. For example, in the device of FIGS. 24-29 , the smaller slot lengths can decrease the overall size of the device in the second expanded position relative to a device having greater slot lengths.

To assemble the inter-body fusion device 10 according to this embodiment, the insert 300 can be positioned between the first plate 100 and the second plate 200 such that the leading edge or end 306 of the insert, the leading edge or end 102 of the first plate, and the leading edge or end 202 of the second plate are facing the same direction. In one aspect, portions of the first plate 100 can overlie the second plate 200. Correspondingly, in one aspect, each longitudinal sidewall 130 of the first plate 100 can substantially align with a longitudinal sidewall 230 of the second plate 200. For example, each longitudinal sidewall of the first plate can substantially overlie at least a portion of a longitudinal sidewall of the second plate. Optionally, each longitudinal sidewall 130 of the first plate 100 can be positioned adjacent to at least a portion of a longitudinal sidewall 230 of the second plate 200 so that at least a portion of the inner surface 120 of the first plate and the inner surface 220 of the second plate can contact each other.

Note that the device according to the embodiment of FIGS. 24-29 can comprise a portion of the first member 302 of the insert coupled to the second member 304, as illustrated in FIGS. 24-26 , or alternatively, the first member can be physically separate from the second member, as illustrated in FIGS. 26-29 .

Also presented herein are methods of using an inter-body fusion device 10 during an inter-body fusion procedure. In one aspect, the method comprises accessing the desired disc space, choosing the inter-body fusion device size with the appropriate height, inserting the inter-body fusion device 10 into the desired area in the disc space, expanding the inter-body fusion device from the first unexpanded position to the second expanded position with longitudinal movement of the insert 300, and adjusting the angle of the of the first plate 100 relative to the second plate. An additional step of packing the interior cavity 15 via the longitudinal duct 339 of the second threaded shaft 336 and the longitudinal pathway 334 of the second member 304 with bone fusion material after expansion is also contemplated. In one aspect, the method of using an inter-body fusion device 10 during an inter-body fusion procedure further comprises the step of securing the insert to the first and second plates. In another aspect, the method of using an inter-body fusion device during an inter-body fusion procedure further comprises the step of securing the inter-body fusion device 10 to the surrounding bony structure.

In one aspect, the step of choosing the inter-body fusion device 10 size with the appropriate height and angle comprises placing an undersized trial device in the disc space, expanding the trial device to the second expanded position, and repeating until the correct height and lordosis is found. The trial height and angle gives the information to prescribe the correct inter-body fusion device for the procedure. In another aspect, the method further comprises selecting a desired embodiment of inter-body fusion device, as described above.

Although several aspects of the invention have been disclosed in the foregoing specification, it is understood by those skilled in the art that many modifications and other aspects of the invention will come to mind to which the invention pertains, having the benefit of the teaching presented in the foregoing description and associated drawings. It is thus understood that the invention is not limited to the specific aspects disclosed hereinabove, and that many modifications and other aspects are intended to be included within the scope of the appended claims. Moreover, although specific terms are employed herein, as well as in the claims that follow, they are used only in a generic and descriptive sense, and not for the purposes of limiting the described invention. 

What is claimed is:
 1. An inter-body fusion device for use in surgery comprising: a first plate having a leading edge or end, a trailing edge or end, an upper bone contact surface, an opposed first plate inner surface, and a first plate longitudinal axis; a second plate having a leading edge or end, a trailing edge or end, a lower bone contact surface, an opposed second plate inner surface, and a second plate longitudinal axis, wherein the first plate substantially overlies the second plate and is positioned such that the first plate longitudinal axis and the second plate longitudinal axis form a device angle; and an insert comprising a first member having a leading edge or end, a trailing edge or end, an upper plate contact surface and an opposed lower plate contact surface, and a second member having a leading edge or end, a trailing edge or end, an upper plate contact surface and an opposed lower plate contact surface, the insert positioned substantially therebetween the first plate and the second plate, wherein movement of the first member longitudinally with respect to the first and second plates moves the first plate longitudinal axis and the second plate longitudinal axis changing the device angle and increases a distance between a portion of the leading edge or end of the first and second plates and movement of the second member longitudinally with respect to the first and second plates moves the first plate longitudinal axis and the second plate longitudinal axis changing the device angle and increases the distance between a portion of the trailing edge or end of the first and second plates, and wherein the first and second members operate independently, enabling a user to selectively alters the distance between the first plate and the second plate and by moving both the first plate longitudinal axis and second plate longitudinal axis to alter the device angle, wherein the trailing edge or end of the first member defines a first bore configured to engage a first threaded shaft, wherein rotation of the first threaded shaft in a first direction moves the first member proximally and rotation of the first threaded shaft in a second direction moves the first member distally, and the second member defines a second bore that extends longitudinally through the second member, the second bore configured to engage a second threaded shaft, wherein rotation of the second threaded shaft in a first direction moves the second member proximally and rotation of the second threaded shaft in a second direction moves the second member distally, wherein a distal end of the second threaded shaft defines a feature to engage an actuation device, such that rotation of the actuation device can rotate the first threaded shaft or the second threaded shaft independently, wherein a longitudinal duct is defined therethrough the second threaded shaft and coaxially aligned through a longitudinal pathway of the second member configured to enable at least a portion of the actuation device to be inserted through the longitudinal duct and coupled to a distal end of the first threaded shaft allowing the actuation device to rotate the first or second threaded shafts independently.
 2. The inter-body fusion device of claim 1, wherein the device angle is substantially 0 degrees such that the first plate and the second plate are substantially parallel to each other.
 3. The inter-body fusion device of claim 1, wherein the device angle is an acute angle between about 1 degree and about 45 degrees.
 4. The inter-body fusion device of claim 1, wherein the device angle is an acute angle between about 5 degrees and about 30 degrees.
 5. The inter-body fusion device of claim 1, wherein the device angle is an acute angle between about 10 degrees and about 20 degrees.
 6. The inter-body fusion device of claim 1, wherein the first plate comprises a pair of longitudinal sidewalls extending from a portion of the first plate inner surface, and the second plate comprises a pair of longitudinal sidewalls extending from a portion of the second plate inner surface, and wherein one of the pairs of longitudinal sidewalls is positioned within the other pair of longitudinal sidewalls.
 7. The inter-body fusion device of claim 6, wherein each of the longitudinal sidewalls of the first plate defines a first inclined slot and a second inclined slot, each slot having a leading end and a trailing end, the leading end being positioned closer to the leading edge or end of the first plate.
 8. The inter-body fusion device of claim 7, wherein the first slot is defined along a first slot axis which is positioned at an acute angle relative to the longitudinal axis of the first plate, and wherein the second slot is defined along a second slot axis which is positioned at an acute angle relative to the longitudinal axis of the first plate.
 9. The inter-body fusion device of claim 8, wherein the first slot axis and the second slot axis are parallel to one another.
 10. The inter-body fusion device of claim 8, wherein the first slot axis and the second slot axis are substantially transverse.
 11. The inter-body fusion device of claim 7, wherein each of the longitudinal sidewalls of the second plate defines a third inclined slot and a fourth inclined slot, each slot having a leading end and a trailing end.
 12. The inter-body fusion device of claim 11, wherein the third slot is defined along a third slot axis which is positioned at an acute angle relative to the longitudinal axis of the second plate, and wherein the fourth slot is defined along a fourth slot axis which is positioned at an acute angle relative to the longitudinal axis of the second plate.
 13. The inter-body fusion device of claim 12, wherein the third slot axis and the fourth slot axis are parallel to one another.
 14. The inter-body fusion device of claim 12, wherein the third slot axis and the fourth slot axis are substantially transverse.
 15. The inter-body fusion device of claim 1, wherein the first member is spaced from the second member.
 16. The inter-body fusion device of claim 1, wherein portions of the first member are positioned and configured to act on portions of the leading edge or end of the first plate and portions of the leading edge or end of the second plate to facilitate expanding portions of the inter-body fusion device by selectively separating portions of the leading edges or ends of the first and second plates.
 17. The inter-body fusion device of claim 16, wherein portions of the second member are positioned and configured to act on portions of the trailing edge or end of the first plate and portions of the trailing edge or end of the second plate to facilitate expanding portions of the inter-body fusion device by selectively separating portions of the trailing edges or ends of the first and second plates.
 18. A method of using an inter-body fusion device during an inter-body fusion procedure comprising: accessing a desired disc space; choosing an inter-body fusion device size with an appropriate height, the inter-body fusion device comprising: a first plate having a leading edge or end, a trailing edge or end, an upper bone contact surface, an opposed first plate inner surface, and a first plate longitudinal axis; a second plate having a leading edge or end, a trailing edge or end, a lower bone contact surface, an opposed second plate inner surface, and a second plate longitudinal axis, wherein the first plate substantially overlies the second plate and is positioned such that the first plate longitudinal axis and the second plate longitudinal axis form a device angle; and an insert comprising a first member having a leading edge or end, a trailing edge or end, an upper plate contact surface and an opposed lower plate contact surface, and a second member having a leading edge or end, a trailing edge or end, an upper plate contact surface and an opposed lower plate contact surface, the insert positioned substantially therebetween the first plate and the second plate, wherein movement of the first member longitudinally with respect to the first and second plates moves the first plate longitudinal axis and the second plate longitudinal axis changing the device angle and increases the distance between the leading edge or end of the first and second plates and movement of the second member longitudinally with respect to the first and second plates moves the first plate longitudinal axis and the second plate longitudinal axis changing the device angle and increases the distance between the trailing edge or end of the first and second plates, and wherein the first and second members operate independently, enabling a user to selectively alters the distance between the first plate and the second plate and by moving both the first plate longitudinal axis and second plate longitudinal axis to alter the device angle, wherein the trailing edge or end of the first member defines a first bore configured to engage a first threaded shaft, wherein rotation of the first threaded shaft in a first direction moves the first member proximally and rotation of the first threaded shaft in a second direction moves the first member distally, and the second member defines a second bore that extends longitudinally through the second member, the second bore configured to engage a second threaded shaft, wherein rotation of the second threaded shaft in a first direction moves the second member proximally and rotation of the second threaded shaft in a second direction moves the second member distally, wherein a distal end of the second threaded shaft defines a feature to engage an actuation device, such that rotation of the actuation device can rotate the first threaded shaft or the second threaded shaft independently, wherein a longitudinal duct is defined therethrough the second threaded shaft and coaxially aligned through a longitudinal pathway of the second member configured to enable at least a portion of the actuation device to be inserted through the longitudinal duct and coupled to a distal end of the first threaded shaft allowing the actuation device to rotate the first or second threaded shafts independently; inserting the inter-body fusion device into the desired disc space; expanding the inter-body fusion device from a first unexpanded position to a second expanded position with longitudinal movement of the insert; and adjusting the angle of the of the first plate relative to the second plate. 